Dr. Yang and Dr. Vlastos of the St. Louis Fetal Care Institute performed a tracheal occlusion using a hydrogel block to help a fetus' lungs expand and grow.

12/21/2009

This article originally appeared in the St. Louis Globe-Democrat on Dec. 17, 2009.

A baby not even born yet may already have been given the gift of life thanks to a pair of fetal surgeons.

Cardinal Glennon Children’s Medical Center fetal surgeon Dr. Edmund Yang, and St. Louis University School of Medicine fetal surgeon Dr. Mike Vlastos carried out an experimental surgery last month at Glennon to help a 20 week-old fetus’ lungs to develop.

The experimental surgery, the first ever in the Midwest and called a Tracheal Occlusion, was carried out to treat Congenital Diaphragmatic Hernia (CDH), a condition that occurs when a hole in the fetus' diaphragm allows the intestines and other vital organs to move into the chest cavity and obstruct normal development of the lungs.

Hydrogel block

For many babies with CDH there is little chance of survival when they are born.

“We are hopeful that this research will allow these babies to survive and achieve a better quality of life,” Vlastos said.

A similar CDH procedure carried out in Europe places a balloon in the fetus' trachea, which obstructs it and allows the lungs to expand normally with fluid. The procedure carried out by Yang and Vlastos places a hydrogel block, a gelatin-like substance, into the trachea instead. The hydrogel block dissolves before birth and eliminates the need for a second surgery to remove the balloon.

The two doctors are part of the St. Louis Fetal Care Institute, collaboration between SSM Cardinal Glennon Children's Medical Center, SSM St. Mary's Health Center and St. Louis University School of Medicine.

The CDH was discovered when a mother, a northwest St. Louis resident, came in for a routine ultrasound. The fetus, a male at 20 weeks of gestation, had lungs that were developed at only 19 percent but eventually rose to only 26 percent of normal growth, Yang said, making him an excellent candidate for the surgery.

On Nov. 25 the doctors placed a small scope through the uterus, into the fetus' mouth and ultimately into the trachea, where the hydrogel block was injected. The baby is expected to be born in mid-January, 2010.

“The mother needed to be quite courageous to make the decision to allow us to do the procedure,” Yang said. “MRI tests have shown that the lung size has nearly doubled since the block was placed,” Yang said.

“It’s important to keep in mind that through our Fetal Care Institute, the vast majority of the babies we evaluate don’t ultimately need to have an intervention,” Vlastos said. “Perhaps only one in 10 or one in 12 have a condition severe enough to warrant an intervention while they’re still in their mom. This little one provided us with an opportunity to do that on a baby whose chance of survival was very, very small, or if this baby did survive, the quality of life would be very difficult.”

“I have tracked over 50 babies with CDH from before birth,” Yang said. “Of the babies with liver in the chest and lungs as small as this baby’s, all of them went on ECMO (heart-lung bypass machine) and only 25 percent survived to go home. This procedure is experimental but these babies have no alternatives. Despite our best care, their outcomes are heart-breaking.”